Skip to main content

Advertisement

SpringerLink
Log in

Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The gold standard of Acetabular fractures treatment is open reduction and internal fixation (ORIF). Our purpose is to assess the short- to medium-term outcomes and complications of surgically treated acetabular fractures. We analysed factors influencing clinical outcomes, incidence of complications and predictors of conversion in total hip arthroplasty (THA).

Materials and methods

We retrospectively analysed 102 patients with acetabular fracture surgically treated between December 2017 and September 2020. We evaluated the quality of reduction with x-ray measuring residual displacement, classified into 3 groups (Matta Radiological Score). At the final follow-up, radiographs were graded according to Matta’s Radiological Outcome Grading, and the clinical outcomes were graded using Oxford Hip Score (OHS).

Results

62 patients were enrolled. OHS was influenced by quality of reduction (p = 0.031), injury severity score (ISS) (p = 0.003) and BMI > 30 (p < 0.0001). The late sequelae were heterotopic ossification (HO) in 13 patients, osteoarthritis (OA) in 22 and avascular necrosis (AVN) in 4. HO was significantly affected by posterior approach and ISS > 15. The analysis showed a correlation between AVN and posterior hip dislocation. OA had a correlation with postoperative quality of reduction (p = 0.014). Eight patients required THA with a significant correlation between THA and posterior dislocation, isolated posterior wall fracture and ISS > 15.

Conclusion

A high rate of patients with acetabular fractures still develop complications and require THA. Identification of predictors for poor outcome may help to inform surgical decision-making regarding options of plate osteosynthesis or ‘Fix and Replace’, to avoid poor outcomes and early revision surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

All data are available in the main text and tables. Additional information can be provided if solicited.

References

  1. Giannoudis PV, Grotz MRW, Papakostidis C, Dinopoulos H (2005) Operative treatment of displaced fractures of the acetabulum. a meta-analysis. J Bone Joint Surg Br 87:2–9

    Article  CAS  PubMed  Google Scholar 

  2. Henry PDG, Kreder HJ, Jenkinson RJ (2013) The osteoporotic acetabular fracture. Orthop Clin North Am 44:201–215. https://doi.org/10.1016/j.ocl.2013.01.002

    Article  PubMed  Google Scholar 

  3. Meena UK, Tripathy SK, Sen RK et al (2013) Predictors of postoperative outcome for acetabular fractures. Orthop Traumatol Surg Res 99:929–935. https://doi.org/10.1016/j.otsr.2013.09.004

    Article  CAS  PubMed  Google Scholar 

  4. Matta JM, Mehne DK, Roffi R (1986) Fractures of the acetabulum early results of a prospective study. Clin Orthop Relat Res 205:241–250

    Article  Google Scholar 

  5. Ceri L, Zanna L, Buzzi R, De Biase P (2021) Obturator dislocation of the hip associated with ipsilateral quadrilateral plate fracture: a rare case report. Trauma Case Rep 32:100451. https://doi.org/10.1016/j.tcr.2021.100451

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wu ES, Jauregui JJ, Banerjee S et al (2015) Outcomes of delayed total hip arthroplasty in patients with a previous ipsilateral acetabular fracture. Expert Rev Med Devices 12:297–306. https://doi.org/10.1586/17434440.2015.1026327

    Article  CAS  PubMed  Google Scholar 

  7. Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 78:1632–1645

    Article  CAS  PubMed  Google Scholar 

  8. Wylde V, Learmonth ID, Cavendish VJ (2005) The Oxford hip score: the patient’s perspective. Health Qual Life Outcomes 3:66. https://doi.org/10.1186/1477-7525-3-66

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brooker AF, Bowerman JW, Robinson RA, Riley LH (1973) Ectopic ossification following total hip replacement incidence and a method of classification. J Bone Joint Surg Am 55:1629–1632

    Article  CAS  PubMed  Google Scholar 

  10. Ficat RP (1985) Idiopathic bone necrosis of the femoral head early diagnosis and treatment. J Bone Joint Surg Br 67:3–9

    Article  CAS  PubMed  Google Scholar 

  11. Veerappa LA, Tippannavar A, Goyal T, Purudappa PP (2020) A systematic review of combined pelvic and acetabular injuries. J Clin Orthop Trauma 11:983–988. https://doi.org/10.1016/j.jcot.2020.09.017

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mears DC, Velyvis JH, Chang C-P (2003) Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-200302000-00026

    Article  PubMed  Google Scholar 

  13. Deo SD, Tavares SP, Pandey RK et al (2001) Operative management of acetabular fractures in Oxford. Injury 32:581–586. https://doi.org/10.1016/S0020-1383(00)00200-X

    Article  CAS  PubMed  Google Scholar 

  14. Ziran N, Soles GLS, Matta JM (2019) Outcomes after surgical treatment of acetabular fractures: a review. Patient Saf Surg 13:16. https://doi.org/10.1186/s13037-019-0196-2

    Article  PubMed  PubMed Central  Google Scholar 

  15. Khira YM, El-Aidy S (2018) Surgical treatment of marginal osteochondral impaction in acetabular fractures. Musculoskelet Surg 102:139–145. https://doi.org/10.1007/s12306-017-0506-8

    Article  CAS  PubMed  Google Scholar 

  16. Moed BR, Yu PH, Gruson KI (2003) Functional outcomes of acetabular fractures. J Bone Joint Surg-Am 85:1879–1883. https://doi.org/10.2106/00004623-200310000-00002

    Article  PubMed  Google Scholar 

  17. Karunakar MA, Shah SN, Jerabek S (2005) Body mass index as a predictor of complications after operative treatment of acetabular fractures. J Bone Joint Surg Am 87:1498–1502. https://doi.org/10.2106/JBJS.D.02258

    Article  PubMed  Google Scholar 

  18. Morris BJ, Richards JE, Guillamondegui OD et al (2015) Obesity increases early complications after high-energy pelvic and acetabular fractures. Orthopedics 38:e881-887. https://doi.org/10.3928/01477447-20151002-54

    Article  PubMed  Google Scholar 

  19. Wollmerstädt J, Pieroh P, Schneider I et al (2020) Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum. BMC Geriatr 20:66. https://doi.org/10.1186/s12877-020-1471-x

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wang P, Kandemir U, Zhang B et al (2019) Incidence and risk factors of deep vein thrombosis in patients with pelvic and acetabular fractures. Clin Appl Thromb Hemost 25:107602961984506. https://doi.org/10.1177/1076029619845066

    Article  Google Scholar 

  21. Fishmann AJ, Greeno RA, Brooks LR, Matta JM (1994) Prevention of deep vein thrombosis and pulmonary embolism in acetabular and pelvic fracture surgery. Clin Orthop Relat Res 305:133–137

    Article  Google Scholar 

  22. Briffa N, Pearce R, Hill AM, Bircher M (2011) Outcomes of acetabular fracture fixation with ten years’ follow-up. J Bone Joint Surg 93:8

    Google Scholar 

  23. Milenković S, Mitković M, Saveski J et al (2013) Avascular necrosis of the femoral head in the patients with posterior wall acetabular fractures associated with dislocations of the hip. Acta Chir Iugosl 60:65–69. https://doi.org/10.2298/aci1302065m

    Article  PubMed  Google Scholar 

  24. Moed BR, Carr SEW, Watson JT (2002) Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg-Am 84:752–758. https://doi.org/10.2106/00004623-200205000-00008

    Article  PubMed  Google Scholar 

  25. Hougaard K, Thomsen PB (1986) Traumatic posterior dislocation of the hip ? prognostic factors influencing the incidence of avascular necrosis of the femoral head. Arch Orth Traum Surg 106:32–35. https://doi.org/10.1007/BF00435649

    Article  CAS  Google Scholar 

  26. Massoud EIE (2018) Neglected traumatic hip dislocation: influence of the increased intracapsular pressure. WJO 9:35–40. https://doi.org/10.5312/wjo.v9.i3.35

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kellam P, Ostrum RF (2016) Systematic review and meta-analysis of avascular necrosis and posttraumatic arthritis after traumatic hip dislocation. J Orthop Trauma 30:10–16. https://doi.org/10.1097/BOT.0000000000000419

    Article  PubMed  Google Scholar 

  28. Firoozabadi R, O’Mara TJ, Swenson A et al (2014) Risk factors for the development of heterotopic ossification after acetabular fracture fixation. Clin Orthop Relat Res 472:3383–3388. https://doi.org/10.1007/s11999-014-3719-2

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lannes X, Moerenhout K, Duong HP et al (2020) Outcomes of combined hip procedure with dual mobility cup versus osteosynthesis for acetabular fractures in elderly patients: a retrospective observational cohort study of fifty one patients. Int Orthop (SICOT) 44:2131–2138. https://doi.org/10.1007/s00264-020-04757-w

    Article  Google Scholar 

  30. Griffin SM, Sims SH, Karunakar MA et al (2013) Heterotopic ossification rates after acetabular fracture surgery are unchanged without indomethacin prophylaxis. Clin Orthop Relat Res 471:2776–2782. https://doi.org/10.1007/s11999-013-2871-4

    Article  PubMed  PubMed Central  Google Scholar 

  31. Elhassan Y, Abdelhaq A, Piggott RP et al (2016) Heterotopic ossification following acetabular fixation: incidence and risk factors: 10-year experience of a tertiary centre. Injury 47:1332–1336. https://doi.org/10.1016/j.injury.2016.03.002

    Article  PubMed  Google Scholar 

  32. Øvre S, Madsen JE, Røise O (2008) Acetabular fracture displacement, roof arc angles and 2 years outcome. Injury 39:922–931. https://doi.org/10.1016/j.injury.2007.12.006

    Article  PubMed  Google Scholar 

  33. Boudissa M, Ruatti S, Kerschbaumer G et al (2016) Part 2: outcome of acetabular fractures and associated prognostic factors—a ten-year retrospective study of one hundred and fifty six operated cases with open reduction and internal fixation. Int Orthop (SICOT) 40:2151–2156. https://doi.org/10.1007/s00264-015-3070-6

    Article  Google Scholar 

  34. Tannast M, Najibi S, Matta JM (2012) Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg-Am 94:1559–1567. https://doi.org/10.2106/JBJS.K.00444

    Article  PubMed  Google Scholar 

  35. Firoozabadi R, Hamilton B, Toogood P et al (2018) Risk factors for conversion to total hip arthroplasty after acetabular fractures involving the posterior wall. J Orthop Trauma 32:607–611. https://doi.org/10.1097/BOT.0000000000001327

    Article  PubMed  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Traumatology and General Orthopaedics, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy

    Luigi Zanna, Lorenzo Ceri, Gianluca Scalici, Debora Boncinelli, Roberto Buzzi & Pietro De Biase

  2. Maidstone and Tunbridge Wells NHS Trust, Tunebridge Wells, UK

    Daniel T. Burchette

Authors
  1. Luigi Zanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lorenzo Ceri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gianluca Scalici
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Debora Boncinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel T. Burchette
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roberto Buzzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pietro De Biase
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LZ, LC and PDB contributed to the study conception and design. Material preparation, data collection and analysis were performed by LZ, SG, LC and DB. The first draft of the manuscript was written by LZ and LC, and all authors commented on previous versions of the manuscript. DTB edited the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Luigi Zanna.

Ethics declarations

Conflict of interest

All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Therefore, no benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical approval

All authors have participated in the research, the article has not been submitted elsewhere and there is no financial interest to report. All patients accepted the proposed treatment and follow-up after an adequate information and written informed consent. The study and follow-up, respecting the criteria of the Declaration of Helsinki, have been approved by Institutional Review Board (IRB) of Azienda Ospedaliera Universitaria Careggi (AOUC) Department of Surgery and Translational Medicine.

Consent for publication

Obtained.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zanna, L., Ceri, L., Scalici, G. et al. Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty. Eur J Orthop Surg Traumatol 33, 2419–2426 (2023). https://doi.org/10.1007/s00590-022-03451-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-022-03451-4

Keywords

Search

Navigation